| Heathrow Internal Medicine Llc | |
|
4106 W Lake Mary Blvd Suite 100 Lake Mary FL 32746-3315 | |
| (407) 333-2273 | |
| (407) 333-3939 |
| Full Name | Heathrow Internal Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4106 W Lake Mary Blvd, Lake Mary, Florida |
| Authorized Official Name and Position | Tedrick Johnson (GROUP VP OPERATIONS) |
| Authorized Official Contact | 4073332273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heathrow Internal Medicine Llc 4106 W Lake Mary Blvd Suite 100 Lake Mary FL 32746-3315 Ph: (407) 333-2273 | Heathrow Internal Medicine Llc 4106 W Lake Mary Blvd Suite 100 Lake Mary FL 32746-3315 Ph: (407) 333-2273 |
| NPI Number | 1033387865 |
|---|---|
| Provider Enumeration Date | 02/14/2008 |
| Last Update Date | 05/28/2014 |
| Medicare PECOS PAC ID | 5294801536 |
|---|---|
| Medicare Enrollment ID | O20080910000226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033387865 | NPI | - | NPPES |
| 000617400 | Medicaid | FL | |
| 307909100 | Medicaid | FL | |
| AM199 | Other | FL | MEDICARE PTAN |
| PTAN DN9084 | Other | FL | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Kristy Jo Magee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760430425 PECOS PAC ID: 2062454986 Enrollment ID: I20050601000395 |
| Provider Name | Edward J Magee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437107190 PECOS PAC ID: 1153364732 Enrollment ID: I20050606000036 |
| Provider Name | Johanne S Dunn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962476044 PECOS PAC ID: 5294756276 Enrollment ID: I20051219000396 |
| Provider Name | Michelle A Cooley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316120504 PECOS PAC ID: 4880777010 Enrollment ID: I20080212000256 |
| Provider Name | Elena M Gabor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417909821 PECOS PAC ID: 8325933955 Enrollment ID: I20080404000706 |
| Provider Name | Manpreet K Gill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336140243 PECOS PAC ID: 4385676154 Enrollment ID: I20080523000517 |
| Provider Name | Jesse Wayne Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245344571 PECOS PAC ID: 5597757161 Enrollment ID: I20080910000530 |
| Provider Name | Daniel R Monette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336112531 PECOS PAC ID: 4587794003 Enrollment ID: I20100610000221 |
| Provider Name | Manoj K Dhariwal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457544629 PECOS PAC ID: 3375782444 Enrollment ID: I20140616000356 |
| Provider Name | Dennis C Blanchette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962894378 PECOS PAC ID: 0941519219 Enrollment ID: I20151028000117 |
| Provider Name | Diana N Moldoveanu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396716528 PECOS PAC ID: 1052384336 Enrollment ID: I20160205000802 |
| Provider Name | Aleksandra Clayton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801225115 PECOS PAC ID: 4880975036 Enrollment ID: I20161229001167 |
| Provider Name | Joshua Shultz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063839421 PECOS PAC ID: 4385954296 Enrollment ID: I20171017001036 |
| Provider Name | Allison Poimboeuf Ferrara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477812824 PECOS PAC ID: 5991939985 Enrollment ID: I20181107003566 |
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